Just diagnosed, questions?

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Priss

Priss

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Hi Everyone,

We were just diagnosed two weeks ago with diabetes, after some urinating issues lead to a blood panel. Priss is 7 years and her blood sugar at the vet was 398, and she had ketones. I found this forum after our second visit and read about the need to change to a low carb diet. Despite having purchased the dry and wet DM food I decided to give Priss wet only after the first day after reading info about this online. The insulin prescribed is Lantus.

Her blood sugar after starting treatment day 3 was 171, day 5 145, and day 8 180. It seemed to me her blood sugar was dropping when I stopped the dry food, but the vet scared me back into feeding it after day 5 by saying the cat is underweight, and that cats need carbs to gain weight, although I thought dry food was part of the problem. In addition the vet said her level was too low at 145, I thought this was the point?

We have tried home testing but no luck yet, the vet said that home testing wasn't the same, and showed me at the office - hers said 94 versus 145, but as I've read thought this was due to the difference in vein blood.

What do you all think about this vet's advice, and the need for weekly testing? Is vet testing really necessary? I can't really afford $67 each time and they want me to come in weekly or more often, this last 10 days has cost $670 already. The vet said I needed to come beck tomorrow but I did not make the appointment.

Thank you for all your help in advance!
 

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Ummm. No, I think the vet wants some ready money coming in or isn't at all familiar with FD- which is very common among vets. Are you comfortable with this vet?

A few things- wet food (that has lower carbs 10% or less) will lower the bg levels so HOME TESTING is necessary AND needed. You do NOT want to shoot insulin at a low number- and Priss seems to have some low numbers there. What dose is she getting? Normal levels for a cat read between 40 and 120, diabetic cats we want 70-150 or so.

It ALWAYS takes a while for the ears to give out blood because we have to get the capillaries flowing. It took about 3 or 4 days for me to get Sneakers ears going. Someone will be getting on and giving you a link to the picture and video on how to test. And testing from the vein is a WHOLE lot different than a capillary test that you can buy at the store. We use Relion Micro which has the cheapest strips (I test Sneakers about 7 or 8 times a day- mainly because I want the data). If the vet wants to test herself ask if it is for free as the $67 bucks goes a long way for a $9 meter and 100 strips for $36- and you get a whole lot more numbers than one.

For the food- diabetic cats need LOW CARB food as that is what helped them to become diabetic in the first place so giving them more is like feeding a candy bar to a diabetic infant and expecting them to be okay. Priss will not gain weight until she starts getting the necessary nutrients out of the food and that won't happen until she gets enough insulin going. Oh- and diabetic cats are literally STARVING, so give them food. They will naturally decrease as they get better (Sneakers was about a month or so).

Ketones- if Priss had ketones you need to continue to test for them as DKA is VERY dangerous and costs between $2000-4000 to treat. You can get ketostix at Walmart as well in the diabetic isle- a few shelves underneath the meter. $7 for 50- just hold the strip in her pee stream, count to 15 and see what color it is. Not so exact, but better than nothing and can ease the mind.

I;ll look for all the links after I post this.

Heather
 
We figure we would test our 2 legged diabetic children; we do the same for our 4 legged ones. Testing before each shot will give you confidence that the dose you are planning on is safe. Testing mid cycle will let you see how the insulin is working. You can do all the testing at home and save money. Tests at the vet are often higher numbers than those at home because most cats are stressed at the vet.

This website by a vet explains why wet low carb food is best: www.catinfo.org

I don't use your insulin, but there are two forums with people who do. Here is the forum for tight regulation and relaxed regulation Either one is fine, depending on your life. Most important on both are the starred topics on the top of the page. They will tell you all you need to know about Lantus, including what you are looking for in terms of blood glucose levels. http://www.felinediabetes.com/FDMB/viewforum.php?f=9

Keep reading and asking questions. We'd love to help you help your kitty.
 
and that cats need carbs to gain weight, although I thought dry food was part of the problem. In addition the vet said her level was too low at 145, I thought this was the point?
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Wow, that sort of defies logic. Her BG isn't too low if it's at 145. And cats don't require carbs to gain weight. They require calories. Cats actually have no dietary need for carbohydrates in their diet.

Dry food is part of the problem. And it causes a multitude of problems besides just diabetes. Here's a link you might want to share with them:
http://www.catinfo.org/?link=felinediabetes The owner of that page is a vet who sometimes posts here.

The numbers that you listed for her BGs.... are those all numbers that she's been tested at the vet? Testing at the vet is not necessary if you learn how to home test. Period. And that $67 per visit would buy you a whole lot of test strips!

Lantus is a great insulin for feline diabetics. What dosage did your vet start her on? And the ketones....did the vet say that they are now gone? You can also check ketones at home using the ketostix that they sell at any pharmacy. You can use a human meter too and it doesn't really matter that the vet's meter and your meter don't agree with each other.

You can also find non-prescription canned food that is better for her than the DM from the vet (much cheaper too). Here is a link to food charts showing the information on many different store brand foods:
http://binkyspage.tripod.com/canfood.html
The key is "% kcal from carbs". We recommend food that is under 10%, and under 7% is even better. Low carbs is a must for a diabetic cat, despite what the vet said about her needing carbs to gain weight. Once her numbers are regulated (and by the way, those numbers you listed are actually really good numbers at this point), she will gain weight on low carb food.

Carl
 
for cat food:
Binky's Page- http://www.felinediabetes.com/diabetic-cat-diets.htm

the reasoning for low cab food:
Dr. Lisa's page- http://www.catinfo.org/

for DKA:
can't find right now

ear testing:
http://www.sugarcats.net/sites/harry/earprick.html

If you continue to shoot into low numbers:
how to treat hypos- viewtopic.php?f=28&t=15887

Also, posting in the Lantus board for more questions and answers specific to your insulin (look in insulin support groups).

I know all this is new and believe me, this is the best place to come to get help. We love kitties and want to help :-D ! I love the stripy grey- we used to have a darker cat named Kit-Kat (sigh, not original but we were kids and he was our first cat so he had to deal with a lot of our mistakes :lol: ).
 
The vet has her at 1/4 of the 5 oz can plus 2 TBSP once every 12 hours followed by the 1 unit of insulin, so 2 units total daily. She mentioned it was Lantus, I think the bottle says glargine and I know the vet rebottled it. Thank you for sending the links - I checked out the food one before. I thought I might be able to return some of the expensive DM canned food and change her to Merrick or the low carb Fancy Feast but the vet said she needed the prescription food, either way I am stuck with it now. I'm concerned about changing her to the wet only and having a hypo episode with the insulin, the vet scared me off of it by saying 145 was too low.

The vet did not ever test for ketones again as far as I know, I was being charged only for a BG and that is all they mentioned, which seems odd regarding the danger. Only the first time did they mention ketosis, they wanted to hospitalize but I elected not to - the cat seems OK? If she was in danger, I thought they would bring it up again, and after reading about DKA I'm pretty confused they didn't test for ketones again. They only brought up pancreatitis testing when I mentioned noticing her lipsmacking - this wasn't included in the "senior" overall blood panel.

I'll check out the links and try again tomorrow, right now Priss won't take any more ear jabs. I'll also look at the lantus forum, I have only seen the general information so far, not checked the insulin specific forums.

The crazy thing is she was always meowing for food so I changed her to the wellness after reading online about corn in friskies dry, thinking maybe she didn't get enough protein - now we have diabetes! I adopted her 6.5 years ago, my parents cared for her the last 5 years and I just got her back this August and learned some more about what goes into cat food.
 
Usually she likes to check out the dinner table when we're cooking :) She also drags her empty food bowl over to whoever has food!
 
Hi Carl,

The numbers are from the vet.

day 3 was 171 (insulin at 720 am, test at 530pm)
day 5 145 (insulin at 720 am, test at 530pm)
started feeding the dry again
day 8 180 (insulin at 720am, test at 1PM)
 
I'm gonna be blunt and say you need a new vet! This one is woefully uneducated about diabetes and feline nutrition. Can you post your city/state? There may be someone nearby who can give you a hand or recommend a vet.

MJ
 
One thing in your vet's favor....the 1u twice a day dose is good for a starting dose. What concerns me is that her numbers really are good, and the dose might actually be more than is needed? Or it could be just right for now. But you don't want to change the diet to all canned lower carb than she is currently eating until you can start home testing. If the diet change improves her BG levels, then the dose might need adjusting downward.

The best thing to do is start home testing. She should be checked before every shot. Also, lantus dosing is based on the number that you would see at the point halfway in between shots (which we refer to as +6). That is the time when the insulin should be at peak effectiveness. It isn't always exactly at six hours after the shot, but that's why we advocate home testing. Eventually, you will collect sufficient data so that you will know how the insulin works over a 12 hour cycle, and the dose will be based upon that data.

There are lots and lots of people here who have years of experience with Lantus (lantus is the brand name, the insulin is actually "glargine" so they are the same thing). There will never be a shortage of people who can help you on a day by day basis to treat Priss and help you to manage this treatment.
No matter what questions you come up with, somebody here will be able to answer them. The knowledge base and experience level of the people on this site is mind-boggling!

One other thing -
The vet has her at 1/4 of the 5 oz can plus 2 TBSP once every 12 hours followed by the 1 unit of insulin, so 2 units total daily.
Click to expand...
So the vet said to only feed her at shot times? Human diabetics do better when they eat multiple small meals throughout the day. So do diabetic kitties. :smile: 4 or more meals a day spreads the boost that food causes to her BG levels more evenly. Lantus is a long-lasting insulin that pretty much works around the clock. Spacing out the food rather than just feeding at 12 hour intervals actually helps the insulin work more effectively. MJ is right. If you can let us know where you live, we might have a member that can steer you to a vet who better understands managing feline diabetes.
Carl
 
Priss said:
The vet has her at 1/4 of the 5 oz can plus 2 TBSP once every 12 hours followed by the 1 unit of insulin, so 2 units total daily. She mentioned it was Lantus, I think the bottle says glargine and I know the vet rebottled it.
Click to expand...

Lantus is the marketing name for glargine.


Um, your vet rebottled the insulin??? How did she do this? The original bottle or pen of Lantus contains sterile insulin. I would not trust any insulin that has been removed from the original bottle or pen and repackaged. Why risk the chance of using potentially contaminted insuiln?

Here are more links to food charts:
Pet Food Nutritional Values list
Dr. Lynne's Wet Food list
List of low carb gluten free Fancy Feast
 
Oh dear, oh dear. Sorry, but it really sounds like your vet is trying to make a quick buck off you. You really need to find a vet who is more up to date on feline diabetes, or at least one that is willing to work with, and not against you. It is YOUR cat, after all - the treatment protocol is your choice, in the end. You do not "need" to feed her crappy prescription food, nor do you "need" to bring her once a week for testing. Your vet needs to understand that you are the owner here, not them.

A few things off the top of my head.

1. Purina DM wet is OK and just OK for diabetics. It is low enough carb however the ingredients are poor (liver, byproducts) and most cats refuse to eat it after a few days/weeks. I would take it back - tell them your cat won't eat it. If they try to push another prescription just say no thanks. Then you can take that money and buy three times as much of a low carb, good quality food.

2. How good is your underweight, starving cat going to feel eating every 12 hrs? Unregulated diabetics are HUNGRY because their bodies cannot process the food they are eating without insulin. You can free feed your cat in the first 9 - 10 hours of the cycle, but most recommend keeping the food in the first half of the cycle (first 6 hrs). I do 3 mini-meals of 1.5oz (half a can) of Fancy Feast per cycle, 3 cans total for my lazy, inactive ~12lb cat.

3. Home testing is 100% absolutely necessary. Ask your vet if a human doctor would ever tell a mother to inject insulin blindly into her diabetic child. If they say yes, RUN, don't walk, away from that vet. If they say no, then WHY WOULD WE DO THAT TO OUR CATS?

4. With all the money you are spending on glucose tests at the vet, you could buy a meter, strips, and lancets and STILL save money, and get multiple tests every single day instead of once a week!!!

5. 145 is not too low, especially if that reading was on an AlphaTrak or cat calibrated blood glucometer. That is a nice number and very close to a regulated diabetic number. You may even have a diet regulated cat that does not need insulin. Home testing will tell you!

I will post again if I can think of any more...
 
Hi, She still is acting very hungry in between her meals. Maybe I will try splitting it up like you mentioned. She licks the bowl clean. Do you think the insulin is OK to use? They sold me 1mL and said they repackage it because a bottle is expensive, which is what I've read here, and also the 6 weeks shelf life. We are in the city of San Diego, CA..
 
I tried giving her a little bit more food today, at 1PM after feeding her at 730AM, and she threw it up. I think it might be because she ate it really fast or it was still too cold from the fridge. I think she may have thrown up and ate it before because I saw a piece of the canned food on her placemat instead of the bowl she ate once, and I didn't think I had spilled it.
 
She's not getting enough food. 1/4 of a 5 ounce can is only 1.25 ounces of food and 2 tablespoons is another ounce, so 2.25 ounces of food * 2 meals = 4.5 ounces of food.

Basically, you can feed roughly 1 oz of food per pound, divided into at least 2 meals, and you can leave it out for her to graze. If she should weigh 8 pounds, that would be 8 ounces of food during the day. If she is a grazer, she could be served 4 oz in the am and 4 in the pm, with the food left out until finished. If she is a binger, divide it into 2 oz meals, 4 times a day, with food at shot time and maybe 3 hours later.

If she needs to gain weight, a higher fat food will provide more calories; Evo Cat and Kitten canned food may fit the bill. In cats and dogs, they estimate that protein and carbohydrate have 3.5 calories per gram and fat has 8.5 calories per gram.
 
Priss said:
Do you think the insulin is OK to use? They sold me 1mL and said they repackage it because a bottle is expensive, which is what I've read here, and also the 6 weeks shelf life. We are in the city of San Diego, CA.
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Here is info on handling a Lantus bottle or pen for diabetic cats: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=151

The 28 day or so shelf life thing is for Human diabetics who can use up a 10 ml bottle or 3 ml pen very quickly.

For diabetic cats and their teeny doses, a bottle or pen can last much longer. It is preferable to use the Lantus SoloStar pens instead of the 10 ml bottle because the bottle tends to poop out (lose effectiveness) more quickly. The pens are 3ml each and you can use a pen to pretty much the last drop. The pens come in a box of five which is basically at least a 5 month supply you'll have on hand. The cost is $225 or so which per pen comes out to $45 or so, much less than the $100+ for a 10 ml bottle that you may need to buy monthly. There are ways to cut the insulin cost down. Some pharmacies may sell individual pens intead of an entire box. I think there may still be a $25 coupon for the Lantus pens. And there's a free pet prescription card that you can use to save some money on Lantus: http://felinediabetes.com/FDMB/viewtopic.php?f=28&t=53397 Some people here buy Lantus from online Canadian pharmacies for much less than what it would cost at a US pharmacy.

Your repackaged 1 ml bottle of Lantus may be ok but since you have no way of knowing how the insulin was repackaged and if sterile technique was used, I wouldn't risk using it. The Lantus info sticky says this: Lantus and Levemir should NOT be repackaged and resold by the vet. If you are buying repackaged insulin from your vet, even if it was transferred into a sterile container, its efficacy and longevity is questionable.

If I were you, I would ask the vet for a prescription for the Lantus SoloStar pens and buy it at the Human pharmacy. You don't use the pen the way a Human diabetic would. You use it just like an insulin bottle: insert insulin syringe needle into the rubber stopper and draw up a dose. Do not inject air or extra insulin back into the pen.

How%20to%20use%20an%20%20insulin%20pen%20for%20cats.jpg
 
I know this is very hard - Vet saying one thing everyone here saying something else. I too have a Vet who didn't always understand or support the home testing - now he does (although he thinks just a test before shots is all that's really needed - he's supportive of me testing more). I've ended up working it out that I use my Vet for confirming, expanding on and bouncing things from this froum off of - the people here know what they are talking about. Dry food isn't the way to go, testing is important etc.
Hang in there - I loved my Vet so I chose to try and re-educate him over to the side more popular here on this forum and it's worked in many ways - but if you aren't particularly attached to your Vet you might want to look elsewhere.
 
I don't think I'll be able to get them to give me a prescription without bringing her in for testing. We've tried the testing with the relion meter, I'm not sure if the one we bought is broken so will try and exchange it. Earlier today we put blood on and nothing showed up, just the droplet showed as if there was no blood. Other tries we had error messages. I'm not sure if they have had many diabetic cats, the receptionist said they didn't. I'll try giving her some more food - we caught her raiding the garbage and she has been sitting by her food bowl. I asked the vet if she should be eating more because I had read somewhere about 15 calories per pound and she weighs 8 (vet says this is underweight) but they said they hadn't heard of that.
 
Hi,
it's actually 20 to 30 calories per pound per day, so she should be eating at least 200 or more per day. That's roughly 1.5 to 2 cans.
Carl
 
One of the cans says 194 calories. I wonder why they said to feed her so little, when she needs to gain weight
 
Do you know what her "ideal weight" would be? That 20-30 calorie formula is for a healthy cat to maintain ideal body weight. A diabetic cat needs more food than normal because they don't digest/metabolize food efficiently. If she needs to gain weight, on top of being diabetic, then it would require that she take in more calories per day than "normal".

If you look on the food charts, all the way to the right hand side is the "calories per can" information.
http://binkyspage.tripod.com/canfood.html

I'm not sure why the vet isn't aware of any of this....

Carl
 
I told the vet my dad said she weighed around 10 pounds and the vet said that sounded about right. The first visit at diagnoses was a little over 8 pounds and she gained 4 ounces since then. I haven't weighed her since the last time they weighed her a week ago. At first you could feel her hips but now they've started to fill out
 
Good that she has gained some back. My cat, Bob, dropped from 18 to under 13 lbs at the time he was diagnosed. He's at 14 lbs now, and has stayed within a couple ounces of that weight for the past 9 months or so. He eats between 275-300 calories a day.

Carl
 
Wow, 5 pounds is a lot of weight to lose. Is 14 pounds his regular weight? I always thought Priss was a bigger cat, but I guess she isn't.
 
14 is what the vet determined would be "ideal" for Bob. Once upon a time, he weighed 22! He was waaaay overweight then though.

Carl
 
Re. cats needing "carby" food to gain weight--my cat gained a pound in three weeks on a wet-only diet. Once the diabetes gets regulated, then the body can use the food properly, thus reversing the weight loss.
 
Priss said:
I don't think I'll be able to get them to give me a prescription without bringing her in for testing. We've tried the testing with the relion meter, I'm not sure if the one we bought is broken so will try and exchange it. Earlier today we put blood on and nothing showed up, just the droplet showed as if there was no blood. Other tries we had error messages. I'm not sure if they have had many diabetic cats, the receptionist said they didn't. I'll try giving her some more food - we caught her raiding the garbage and she has been sitting by her food bowl. I asked the vet if she should be eating more because I had read somewhere about 15 calories per pound and she weighs 8 (vet says this is underweight) but they said they hadn't heard of that.
Click to expand...
I am thinking it may be time to research some other vets in your area. Look for some who are familiar with contemporary feline diabetes management & support home testing, using a long acting insulin (ie, NOT Humulin), and feeding low carbohydrate canned food.

Or, if you really, really like and otherwise trust this vet, you are going to have to start providing educational materials for him, like this one:

Glargine & BG control-Roomp & Rand_2009-JFMS
 
Robbie went from 22+ to 17 and he looked awful. He's settled in around 20.5 and that seems about right - but he's a Maine Coon and pretty big boned.
 
I finally got the blood testing to work. I gave her the same 2Tbsp dry but one half of the wet prescription food at 7:20 AM and also 1 Wellness jerky treat today. Her test was 190 at 1:30PM. We cheered because it finally worked - but isn't this higher than it should be? Will try testing again later today. I'm not sure if the medicine is even good any more because the vet gave it to us 4/20. We need to figure out how to get a prescription still. Someone told me you don't need a prescription to get insulin at a pet store near here but I'm not sure if that's believable.
 
I agree with the others--in order for your cat to gain weight, you need to get her blood sugar under control. Feeding dry food will make this infinitely more difficult. The DM canned is ok, but it's pretty much the same thing as Fancy Feast (also sold by Purina), so you're paying a huge markup just for the label. Remember that your vet makes money by selling you prescription food, so the insistence on feeding it is not always motivated in your best interests. There is nothing in prescription food that makes it better to feed a diabetic than low carb commercial foods.

In fact, there are many low carb canned foods that are higher calorie than the DM and help Priss gain some wait back. Wellness kitten, Wellness turkey, and Wellness chicken are are low carb and high calorie, as are the canned EVO foods, and the Merrick's before grain foods. Any of these will be cheaper than the DM and better in both ingredients and calories for your cat.
 
190 isn't a bad number at all. When in the cycle did it come? We suggest new diabetics not shoot if they get under 200 for a preshot number, but wait 20 minutes without feeding and retest. Not only might you want to shoot a lower dose into that number, but you would want to be sure it is rising, not going down. So a 190 preshot would be a lower number. If 190 came midcycle, that does show the insulin is working. As you get more data, you can be more adventurous with your doses and shoot at lower numbers, but not until you know how the insulin is working.

We say regulated cats on insulin generally run in the 250 range at preshot with midcycle numbers 100s or below. We worry when a cat on insulin dips down into the 40 range. Off insulin, cats can range from 40-120 with the majority of the time in double digits.

If you are in Canada, you may be able to get human insulins like Lantus and Levemir without a script. In the US, you do need one from a vet.

It sounds like you are making strides getting rid of the dry. Watch the numbers as even a few pieces can make a drastic difference.
 
Hello,

Since we're able to test I am going to try to phase out the dry food. This morning I gave her canned only and then her shot. At the evening shot I wasn't able to test her so gave her a spoonful of dry and mostly canned. 3 hours after the shot she was at 168 and five and a half hours at 129. I think I'll try taking the dry out little by little. I'm worried her blood sugar will drop too low. I leave for work in the morning after her shot so there is some concern.

Thanks,

Elizabeth
 
Priss said:
Hello,

Since we're able to test I am going to try to phase out the dry food. This morning I gave her canned only and then her shot. At the evening shot I wasn't able to test her so gave her a spoonful of dry and mostly canned. 3 hours after the shot she was at 168 and five and a half hours at 129. I think I'll try taking the dry out little by little. I'm worried her blood sugar will drop too low. I leave for work in the morning after her shot so there is some concern.

Thanks,

Elizabeth
Click to expand...

If she's dropping that low on 1u while you're still giving dry food, I would recommend dropping the the dose down to .5u every 12 hrs until she's done transitioning to a canned only diet to be safe. You can always raise the dose again in a few days if .5u is not an effective dose. With her being underweight, it's very possible she might end up needing less than a unit, like .5u or .75u.

I would also leave her access to canned food while you're at work--you can freeze it and leave it out or add some water too it. She needs to gain weight so unless she's a scarf-and-barf cat both of those would work. If she is one of those cats that eats so fast she pukes if she has free access to canned food, you can get an auto-feeder on amazon to put frozen portions in and set them to release at specific times while you're gone. That's what I did with Bandit since I'm gone for 12 hrs during the day for work.
 
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